NURSING THEORIES AND MODELS

IMPORTANT THEORISTS:

1. FLORENCE NIGHTINGALE- ENVIRONMENTAL THEORY

 First nursing theorist

 Unsanitary conditions posed health hazard (Notes on Nursing, 1859)
 5 components of environment
 ventilation, light, warmth, effluvia, noise
 External influences can prevent, suppress or contribute to disease or
death.
Nightingale’s Concepts
1. Person

 Patient who is acted on by nurse

 Affected by environment
 Has reparative powers
2. Environment

 Foundation of theory. Included everything, physical, psychological, and

social
3. Health

 Maintaining well-being by using a person’s powers

 Maintained by control of environment
4. Nursing

 Provided fresh air, warmth, cleanliness, good diet, quiet to facilitate

person’s reparative process
2. HILDEGARD PEPLAU -INTERPERSONAL RELATIONS MODEL

 Based on psychodynamic nursing

 using an understanding of one’s own behavior to help others identify their
difficulties
 Applies principles of human relations
 Patient has a felt need
Peplau’s Concepts
1. Person
  An individual; a developing organism who tries to reduce anxiety caused
by needs
 Lives in instable equilibrium
2. Environment

 Not defined
3. Health

 Implies forward movement of the personality and human processes toward

creative, constructive, productive, personal, and community living
4. Nursing

 A significant, therapeutic, interpersonal process that functions

cooperatively with others to make health possible
 Involves problem-solving
3. VIRGINIA HENDERSON -THE NATURE OF NURSING
"The unique function of the nurse is to assist the individual, sick or well, in the performance of
those activities contributing to health or its recovery (or to peaceful death) that he would perform
unaided if he had the necessary strength, will, or knowledge. And to do this in such a way as to
help him gain independence as rapidly as possible. She must in a sense, get inside the skin of
each of her patients in order to know what he needs".

4. FAY ABDELLA- TOPOLOGY OF 21 NURSING PROBLEMS

 A list of 21 nursing problems
 Condition presented or faced by the patient or family.
 Problems are in 3 categories
 physical, social and emotional
 The nurse must be a good problem solver
Abdella’s Concepts
1. Nursing

 A helping profession
 A comprehensive service to meet patient’s needs
 Increases or restores self-help ability
 Uses 21 problems to guide nursing care
2. Health

 Excludes illness
 No unmet needs and no actual or anticipated impairments
3. Person
  One who has physical, emotional, or social needs
 The recipient of nursing care.
4. Environment

 Did not discuss much

 Includes room, home, and community
5. IDA JEAN ORLANDO- DELIBERATIVE NURSING PROCESS

 The deliberative nursing process is set in motion by the patient’s behavior

 All behavior may represent a cry for help. Patient’s behavior can be verbal
or non-verbal.
 The nurse reacts to patient’s behavior and forms basis for determining
nurse’s acts.
 Perception, thought, feeling
 Nurses’ actions should be deliberative, rather than automatic
 Deliberative actions explore the meaning and relevance of an action.
6. DOROTHY JOHNSON-BEHAVIORAL SYSTEMS MODEL

 The person is a behavioral system comprised of a set of organized,

interactive, interdependent, and integrated subsystems
 Constancy is maintained through biological, psychological, and
sociological factors.
 A steady state is maintained through adjusting and adapting to internal and
external forces.
Johnson’s 7 Subsystems
 Affiliative subsystem - social bonds
 Dependency - helping or nuturing
 Ingestive - food intake
 Eliminative - excretion
 Sexual - procreation and gratification
 Aggressive - self-protection and preservation
 Achievement - efforts to gain mastery and control
Johnson’s Concepts
1. Person

 A behavioral system comprised of subsystems constantly trying to

maintain a steady state
2. Environment

 Not specifically defined but does say there is an internal and external
environment
3. Health

 Balance and stability.

4. Nursing

 External regulatory force that is indicated only when there is instability.

7. MARTHA ROGERS -UNITARY HUMAN BEINGS
Energy fields

 Fundamental unity of things that are unique, dynamic, open, and infinite
 Unitary man and environmental field
Universe of open systems

 Energy fields are open, infinite, and interactive

Pattern

 Characteristic of energy field

 A wave that changes, becomes complex and diverse
Pandimensionality

 A nonlinear domain with out time or space

Roger’s Definitions
Integrality

 Continuous and mutual interaction between man and environment

Resonancy

 Continuous change longer to shorter wave patterns in human and

environmental fields
Helicy

 Continuous, probabilistic, increasing diversity of the human and

envrionmental fields.
 Characterized by nonrepeating rhymicities
 Change
8. DOROTHEA OREM- SELF-CARE MODEL

 Self-care comprises those activities performed independently by an

individual to promote and maintain person well-being
 Self care agency is the individual’s ability to perform self care activities
  Self- care deficit occurs when the person cannot carry out self-care
 The nurse then meets the self-care needs by acting or doing for; guiding,
teaching, supporting or providing the environment to promote patient’s
ability
 Wholly compensatory nursing system-Patient dependent
 Partially compensatory- Patient can meet some needs but needs nursing
assistance
 Supportive educative-Patient can meet self care requisites, but needs
assistance with decision making or knowledge
9. IMOGENE KING-GOAL ATTAINMENT THEORY

 Open systems framework

 Human beings are open systems in constant interaction with the
environment
 Personal System
 individual; perception, self, growth, development, time space, body
image
 Interpersonal
 Society
 Personal System
 Individual; perception, self, growth, development, time space, body
image
 Interpersonal
 Socialization; interaction, communication and transaction
 Society
 Family, religious groups, schools, work, peers
 The nurse and patient mutually communicate, establish goals and take
action to attain goals
 Each individual brings a different set of values, ideas, attitudes,
perceptions to exchange
10. BETTY NEUMAN - HEALTH CARE SYSTEMS MODEL

 The person is a complete system, with interrelated parts

 maintains balance and harmony between internal and external
environment by adjusting to stress and defending against tension-
producing stimuli
 Focuses on stress and stress reduction
 Primarily concerned with effects of stress on health
 Stressors are any forces that alter the system’s stability
 Flexible lines of resistance - Surround basic core
 Internal factors that help defend against stressors
  Normal line of resistance -  Normal adaptation state
 Flexible line of defense - Protective barrier, changing, affected by variables
 Wellness is equilibrium
Nursing interventions are activates to:

 strengthen flexible lines of defense

 strengthen resistance to stressors
 maintain adaptation
11. SISTER CALISTA ROY - ADAPTATION MODEL
Five Interrelated Essential Elements

1. Patiency- The person receiving care

2. Goal of nursing- Adapting to change
3. Health-Being and becoming a whole person
4. Environment
5. Direction of nursing activities- Facilitating adaptation
 The person is an open adaptive system with input (stimuli), who adapts by
processes or control mechanisms (throughput)
 The output can be either adaptive responses or ineffective responses
12. JEAN WATSON - PHILOSOPHY AND SCIENCE OF CARING

 Caring can be demonstrated and practiced

 Caring consists of carative factors
 Caring promotes growth
 A caring environment accepts a person as he is and looks to what the
person may become
 A caring environment offers development of potential
 Caring promotes health better than curing
 Caring is central to nursing
WATSON’S 10 CARATIVE FACTORS
 Forming humanistic-altruistic value system
 Instilling faith-hope
 Cultivating sensitivity to self and others
 Developing helping-trust relationship
 Promoting expression of feelings
 Using problem-solving for decision making
 Promoting teaching-learning
 Promoting supportive environment
 Assisting with gratification of human needs
 Allowing for existential-phenomenological forces
Watson’s Concepts
 Person
 Human being to be valued, cared for, respected, nurtured,
understood and assisted
 Environment
 Society
 Health
 Complete physical, mental and social well-being and functioning
 Nursing
 Concerned with promoting and restoring health, preventing illness
13. ROSEMARY PARSE - HUMAN BECOMING THEORY

 Human Becoming Theory includes Totality Paradigm

 Man is a combination of biological, psychological, sociological and
spiritual factors
 Simultaneity Paradigm
 Man is a unitary being in continuous, mutual interaction with
environment
 Originally Man-Living-Health Theory
Parse’s Three Principles
 Meaning
 Man’s reality is given meaning through lived experiences
 Man and environment cocreate
 Rhythmicity
 Man and environment cocreate ( imaging, valuing, languaging) in
rhythmical patterns
 Cotranscendence
 Refers to reaching out and beyond the limits that a person sets
 One constantly transforms
 Person
 Open being who is more than and different from the sum of the parts
 Environment
 Everything in the person and his experiences
 Inseparable, complimentary to and evolving with
 Health
 Open process of being and becoming. Involves synthesis of values
 Nursing
 A human science and art that uses an abstract body of knowledge to
serve people
14. MADELEINE LEININGER - CULTURE CARE DIVERSITY AND
UNIVERSALITY
  According to transcultural nursing, the goal of nursing care is to provide
care congruent with cultural values, beliefs, and practices
 Sunrise model consists of 4 levels that provide a base of knowledge for
delivering cultural congruent care.
 Cultural care preservation
 help maintain or preserve health, recover from illness, or face death
 Cultural care accommodation
 help adapt to or negotiate for a beneficial health status, or face
death
 Cultural care re-patterning
 help restructure or change lifestyles that are culturally meaningful
15. PATRICIA BENNER - FROM NOVICE TO EXPERT

 Described 5 levels of nursing experience and developed exemplars and

paradigm cases to illustrate each level
1. Novice
2. Advanced beginner
3. Competent
4. Proficient
5. Expert
 Levels reflect:
 movement from reliance on past abstract principles to the use of
past concrete experience as paradigms
 change in perception of situation as a complete whole in which
certain parts are relevant
16. LYDIA E. HALL - THE CORE, CARE AND CURE

 The theory contains of three independent but interconnected circles:

1. the core,
2. the care and
3. the cure
 The core is the person or patient to whom nursing care is directed and
needed. The core has goals set by himself and not by any other person.
The core behaved according to his feelings, and value system.
 The care circle explains the role of nurse
 The cure is the attention given to patients by the medical professionals.